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Re: [FH] Prognosis For HCM/RCM

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  • acrocat@rocketmail.com
    Hi Jim ... End-stage HCM is recognized on echocardiogram by the decrease in heart function and the decrease in movement of the walls, and thickness. It s as
    Message 1 of 13 , Feb 2, 2012
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      Hi Jim

      Just addressing a few things in your post:

      --- In feline-heart@yahoogroups.com, Jim Sinclair <jisincla@...> wrote:
      > Again, I have not studied this at all and what I have to say is mere
      > speculation of a layperson: It seems that wall thickness alone is not
      > the whole story, in that thickness can decrease even as disease
      > progresses?

      End-stage HCM is recognized on echocardiogram by the decrease in heart function and the decrease in movement of the walls, and thickness. It's as if the heart begins to scar down, although that's not exactly what happens. These hearts can resemble HCM hearts, in that the walls measure normal but the heart function is bad.


      > Before Clipsy died, I was wondering what the purpose was of repeat
      > echocardiograms. She was still alive six months after the prediction
      > of her imminent death, she was *not* suffering from difficulty
      > breathing or any other apparent distress, she was enjoying a good
      > quality of life--what would the echocardiogram tell us that we didn't
      > already know? We knew she had HCM, and we knew what medications and
      > supplements she was taking,

      I would do echocardiograms repeatedly for my own cat. I would want to know, for example, if the heart started to get this "scarred down" appearance. I would want to know if his heart function was declining, if the pressure in his atrium indicated that a heart failure relapse was imminent, if there was "smoke" in the atrium, if there was a big ugly clot stuck in the atrium (I might euthanize in that case, personally, rather than wring my hands at home waiting for that thing to leave the heart), etc.

      You can also add on meds in some cases, depending on what you see.

      If your cat chooses the 'pleural effusion' (rather than edema) form of CHF, you can see if he's building up more effusion, too.

      If the disease looks end stage, there may not be much to do. If money is an issue, cats can certainly be managed "remotely" based on symptoms, but more info can always help you plan for the disease and perhaps add or change meds.
    • joanne marbut
      If the cat has a bacterial infection not related to the heart disease, then yes, the cat can be on antibiotics such as if it had a UTI or a skin infection, a
      Message 2 of 13 , Feb 2, 2012
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        If the cat has a bacterial infection not related to the heart disease, then yes, the cat can be on antibiotics such as if it had a UTI or a skin infection, a cut, etc.  But I haven't heard of antibiotics being prescribed for HCM specifically. 

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      • acrocat@rocketmail.com
        Hi Dick I would love it if there were a drug out there to improve or eliminate HCM in cats. Everyone would. HCM comes with a grave prognosis in humans as
        Message 3 of 13 , Feb 2, 2012
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          Hi Dick

          I would love it if there were a drug out there to improve or eliminate
          HCM in cats. Everyone would. HCM comes with a grave prognosis in
          humans as well, so a drug to cure or lessen the severity of HCM would
          have a huge market.

          There are two maxims in science which apply to your statement:

          >I personally have seen what appears to be clear
          > echocardiographic evidence that medications (enalapril) have resulted
          in visible
          > improvement of Jesse's condition (HCM/RCM).

          The first is:
          The plural of "anecdote" is not "data." :) That's self-explanatory.

          The other is, association is not causation. This means that if you eat
          a banana and then puke, it does not mean that bananas are toxic or that
          they cause vomiting when ingested by humans. You ate one, and then got
          sick, but it does not mean that the banana made you sick. Another
          example would be if you started an exercise program and then had patches
          of itchy skin on your torso. This does not mean that exercise causes
          rashes in humans. (It probably means you're irritated by whatever type
          of fabric you're wearing, or the soap you use for exercise clothes,
          etc.) Association (bananas and stomach upset, and exercise and rashes)
          is not causation.

          So, starting enalapril and seeing a change in echo dimensions does not
          mean that enalapril cures or mitigates HCM. There are hundreds of
          thousands of animals and millions and millions of people on enalapril
          who have not had any cardiac benefits from enalapril. We'd expect this,
          as it has no direct action on the heart.


          --- In feline-heart@yahoogroups.com, nyppsi@... wrote:
          > While it is commonly preached & accepted that HCM is not a reversible
          or
          > curable affliction, I repeatedly read posts indicating that
          echocardiograms
          > have, in some cases, shown reductions in the thickness of atrium
          walls
          > after a period of medication and reduction or elimination of valve
          leakage.

          You've also probably read more posts in which someone said their cat had
          CHF, or a saddle thrombus, or passed away, I'd bet. Many of these cats
          were on the same meds and supplements--what about them?

          I'd also note that wall thickness can change with the disease; it is
          heart function (specifically diastolic--the relaxation--function) that
          you'd monitor. As I described in a recent post, some cats lose
          thickness as the disease progresses. It's also possible for the walls
          to get thicker or thinner for reasons that are entirely and completely
          mysterious. A cat can be diagnosed with bad HCM and then "plateau" for
          months or years. Other cats crash within weeks or months. HCM does
          what it wants--no one can pull it off of whatever track it's on, and
          believe me people have tried their absolute best.

          As for valve leakage, I assume you still mean cats. In cats with the
          obstructive form of HCM (called HOCM, or HCM with SAM), lowering the
          heart rate can lower the obstruction i.e. the valve is less "leaky."
          This is because the leakage is more prominent when the heart rate is
          higher, not because they've been cured by a heart-rate-lowering drug.
          Of course, if their HCM regresses (again, for reasons that are unclear),
          the obstruction can lessen as well.

          > Cardiologists always seem to tend to take the "worst case" approach,
          > conceding only that medications may slow the progress of the
          condition, but not
          > reverse it.

          Again, humans with HCM have the full force of a pharmaceutical industry
          which would find a cure for HCM incredibly lucrative behind them, and
          they aren't getting cured. I'm sorry, there is no medication to reverse
          HCM. There just isn't.

          > I don't want to take the negative fatalistic viewpoint that seems
          > to be the stock-and-trade of veterinary cardiologists. I often wonder
          if,
          > in some cases, that's their way of generating more echo business
          ($450.00 a
          > pop in my area).

          I'm glad you don't want to take the view that cardiologists are
          withholding lifesaving medications for HCM cats out of greed. That
          would be an unfair and incredibly cynical view.

          Adriann



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        • ERIC LEE
          I am sorry. I worked 12 hours yesterday so I didnt type so well. He ha an upper repiratory so thats why I asked my vet for antibiotics. I am just being very
          Message 4 of 13 , Feb 3, 2012
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            I am sorry. I worked 12 hours yesterday so I didnt type so well. He ha an upper repiratory so thats why I asked my vet for antibiotics. I am just being very cautious and worrysome
             
             
            Thank you for all of your replies!!!

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          • acrocat@rocketmail.com
            Most URIs are caused by viruses and not bacteria, so antibiotics won t help. If he has yellow snotty stuff, then antibiotics would help.
            Message 5 of 13 , Feb 3, 2012
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              Most URIs are caused by viruses and not bacteria, so antibiotics won't help. If he has yellow snotty stuff, then antibiotics would help.
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